Figures
- FIGURE 1
Systematic review: forest plot of area under the curve (AUC) values with 95% confidence intervals (CIs) of hand devices (mainly the micro-spirometers COPD-6 and Piko-6), questionnaires, or both hand devices and questionnaires. The COPD-6 score was based on micro-spirometry results. PEF: peak expiratory flow; CDQ: COPD diagnostic questionnaire; COPD-PS: COPD population screener; VAFOSQ: veterans’ airflow obstruction screening questionnaire; PUMA: PUMA study questionnaire; LFQ: lung function questionnaire; 11-Q: 11-Q COPD screening questionnaire; SCSQ: Salzburg COPD-screening questionnaire; EGARPOC: EGARPOC study questionnaire; RHSQ: respiratory health screening questionnaire.
- FIGURE 2
Descriptive analysis and meta-analysis: scatterplot of sensitivities and specificities, as well as summary receiver operating characteristic (ROC) curves (including prediction region) for a) the COPD diagnostic questionnaire; b) the COPD population screener questionnaire; and c) micro-spirometers. AUC: area under the curve; CI: confidence interval; NA: not available.
Tables
- TABLE 1
Hand devices
First author [ref.] Year Country Sample size Sample population Device Cut-off Sensitivity % Specificity % AUC Ronaldson [30]
2018 UK 216 ≥35 years of age and current smokers Wheezometer
Wheezometer score ≥3
4.4
93.6
0.49
PEF
PEF <80%
86.1
67.5 0.77 Micro-spirometer
FEV1 <80% pred, FVC <80% pred, or FEV1/FVC <70% pred
88.9
57.9 0.73 Fujita [38] 2020 Japan 1001 No previous diagnosis of asthma, TB and lung cancer COPD-6 score# COPD-6 score ≥30 85.7 74.6 0.82 Dickens [24] 2020 UK 544 ≥40 years of age with respiratory symptoms or clinically diagnosed COPD COPD-6 FEV1/FEV6 ≤0.77 82.8 85 NA Labor [33] 2016 Croatia 227 40–60 years of age and ≥20 pack-years, with no previous diagnosis of COPD COPD-6 FEV1/FEV6 ≤0.78 71 89 0.83 Kim [25] 2016 South Korea 190 ≥40 years of age and >10 pack-years, with no previous COPD diagnosis COPD-6 FEV1/FEV6 ≤0.77 72.7 77.1 0.76 Llordes [47] 2017 Spain 407 ≥40 years of age and ≥1 pack-year, with no previous diagnosis of COPD COPD-6 FEV1/FEV6 ≤0.78 87.9 72.3 0.87 Represas-Represas [42] 2016 Spain 362 ≥40 years of age and >10 pack-years, with respiratory symptoms and no previous respiratory diagnosis COPD-6 FEV1/FEV6 ≤0.78 91.2 52.8 0.8 Thorn [39] 2012 Sweden 305 40–85 years of age and >15 pack-years COPD-6 FEV1/FEV6 ≤0.73 79.2 80.3 0.84 Miravitlles [45] 2012 Spain 173 Controls: ≥35 years of age and no previous diagnosis of COPD Cases: COPD stages I and II COPD-6 FEV1/FEV6 ≤0.75 84.6 85 0.85 Hidalgo Sierra [44] 2018 Spain 155 ≥40 years of age and ≥10 pack-years, with respiratory symptoms and no previous diagnosis of COPD Piko-6 FEV1/FEV6 ≤0.69 100 97.2 NA Van den Bemt [34] 2014 The Netherlands 104 ≥50 years of age and ≥1 pack-year, with respiratory symptoms and no previous diagnosis of COPD Piko-6 FEV1/FEV6 ≤0.72 93.2 85 0.94 Frith [43] 2011 Australia 204 ≥50 years of age, smoker/ex-smoker and no previous diagnosis of obstructive lung disease Piko-6 FEV1/FEV6 ≤0.74 81 71 0.85 Sichletidis [26] 2011 Greece 1078 ≥40 years of age and no previous diagnosis of COPD Piko-6 Post-bronchodilator FEV1/FEV6 ≤0.69 80 95 NA AUC: area under the curve; PEF: peak expiratory flow; FEV1: forced expiratory volume in 1 s; FEV6: forced expiratory volume in 6 s; FVC: forced vital capacity; TB: tuberculosis; NA: not available. #: COPD-6 score was based on micro-spirometry results.
- TABLE 2
Questionnaires
First author [ref.] Year Country Sample size Sample population Questionnaire Cut-off# Sensitivity % Specificity % AUC Lopez Varela [37] 2019 Mexico 974 ≥40 years of age and ≥10 pack-years, or ≥50 pipes per year or ≥50 cigars per year and/or exposure to biomass smoke PUMA ≥5 85.4 37.6 0.70 Fujita [38] 2020 Japan 1001 No previous diagnosis of asthma, TB and lung cancer Changed CDQ ≥18 81.6 59.7 0.73 Ronaldson [30] 2018 UK 216 ≥35 years of age and current smokers COPD-PS Standard scoring criteria 53.3 78.6 0.66 CDQ Standard scoring criteria 81.5 52.3 0.67 Spyratos [28] 2017 Greece 3234 >40 years of age and ≥10 pack-years CDQ ≥17 74 72 0.80 COPD-PS ≥5 56 90 0.79 LFQ ≤18 79 68 0.81 Weiss [31] 2017 Austria 775 ≥40 years of age SCSQ ≥2 67.1 58.9 0.66 Demirci [40] 2017 Turkey 357 40–65 years of age, with no previous history of obstructive lung disease CAT ≥11 66.7 75.2 NA Sogbetun [27] 2016 USA 376 No limitation VAFOSQ ≥25 66 43 0.58 255 No limitation 11-Q ≥5 94 9 0.61 362 No limitation COPD-PS ≥5 69 46 0.62 376 No limitation LFQ ≤18 95 14 0.66 336 No limitation Personal level screener COPD Questionnaire algorithm 50 69 0.59 Lopez Varela [32] 2016 Argentina, Colombia, Venezuela, Uruguay 1540 ≥40 years of age and ≥10 pack-years, or ≥50 pipes per year or ≥50 cigars per year and/or exposure to PUMA ≥25 (weighted) 76.3 69.3 0.79 biomass smoke ≥5 (simple) 74.2 64.8 0.76 Sogbetun [46] 2016 USA 278 All patients with a previously scheduled office visit VAFOSQ (retrospective validation) ≥25 59.9 69.8 0.72 Llordes [47] 2017 Spain 407 ≥40 years of age and ≥1 pack-year, with no EGARPOC 13 72.9 58.3 0.68 previous diagnosis of RHSQ >17 73.8 56 0.72 COPD COPD-PS ≥4 80.4 47.7 0.65 Two screening questions Both positive 59.8 51.7 0.56 Stanley [29] 2014 Australia 1054 40–85 years of age and former or current smokers, with no previous diagnosis CDQ ≥16.5 79.7 46.8 0.71 of COPD ≥19.5 63 70.1 Cui [35] 2012 China 150 ≥40 years of age; COPD patients (n=100) and non-COPD patients (n=50) Discriminant function model NA 89 82 NA Miravitlles [45] 2012 Spain 173 Controls: ≥35 years of age and no previous diagnosis of COPD Cases: COPD COPD-PS (Spanish) ≥4 93.6 64.8 0.79 stages I and II ≥5 65.4 88 Sichletidis [26] 2011 Greece 1078 ≥40 years of age and no previous diagnosis of COPD CDQ ≥17 80 95 NA Frith [43] 2011 Australia 204 ≥50 years of age, smoker/ex-smoker and no previous diagnosis of obstructive CDQ ≥16.5 91 37 0.72 lung disease ≥19.5 71 62 Kotz [36] 2008 The Netherlands 676 40–70 years of age and >10 pack-years, with respiratory symptoms and no previous CDQ ≥16.5 89.2 24.4 0.65 respiratory diagnosis ≥19.5 65.8 54.0 Price [41] 2006 UK, USA 246 ≥40 years of age and smokers, with no previous respiratory CDQ ≥16.5 58.7 77 0.82 diagnosis ≥19.5 80.4 57.5 AUC: area under the curve; TB: tuberculosis; PUMA: PUMA study questionnaire; COPD-PS: COPD population screener; CDQ: COPD diagnostic questionnaire; LFQ: lung function questionnaire; SCSQ: Salzburg COPD-screening questionnaire; CAT: COPD assessment test; VAFOSQ: veterans airflow obstruction screening questionnaire; 11-Q: 11-Q COPD screening questionnaire; EGARPOC: EGARPOC study questionnaire; RHSQ: respiratory health screening questionnaire; NA: not available. #: cut-off based on questionnaire score.
- TABLE 3
Questionnaires and hand devices
First author [ref.] Year Country Sample size Sample population Combination Cut-off Sensitivity % Specificity % AUC Fujita [38] 2020 Japan 1001 No previous diagnosis of asthma, TB and lung cancer Changed CDQ and COPD-6 score Joined score ≥27 87.8 73.1 0.87 Sichletidis[26] 2011 Greece 1078 ≥40 years of age and no previous diagnosis of COPD CDQ and Piko-6 Questionnaire score ≥17 and post-bronchodilator FEV1/FEV6 <0.7 72 97 NA AUC: area under the curve; TB: tuberculosis; CDQ: COPD diagnostic questionnaire; FEV1: forced expiratory volume in 1 s; FEV6: forced expiratory volume in 6 s; NA: not available.
Supplementary Material
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Supplementary_tables_and figures ERR-0350-2020_Supplementary_tables_and_figures
